March 1984: the results of a drug trial are translated into the message that fatty foods will cause heart disease. (Time magazine © 1984 Time Inc. Reprinted by permission.)

But this was not the message of Steinberg’s “consensus” panel, which was composed exclusively of lay experts and clinical investigators who “were selected to include only [those] who would, predictably, say that all levels of blood cholesterol in the United States are too high and should be lowered,” as Oliver wrote in a Lancet editorial following the conference. “And, of course, this is exactly what was said.” Indeed, the consensus conference report, written by Steinberg and his panel, revealed no evidence of any discord or dissent. There was “no doubt,” it concluded, that low-fat diets “will afford significant protection against coronary heart disease” to every American over the age of two. The NIH Consensus Conference officially gave the appearance of unanimity where no unanimity existed. After all, if there had been a true consensus, as Steinberg himself later explained, “you wouldn’t have had to have a consensus conference.”

Chapter 4

Chapter Four

THE GREATER GOOD

In reality, those who repudiate a theory that they had once proposed, or a theory that they had accepted enthusiastically and with which they had identified themselves, are very rare. The great majority of them shut their ears so as not to hear the crying facts, and shut their eyes so as not to see the glaring facts, in order to remain faithful to their theories in spite of all and everything.

MAURICE ARTHUS, Philosophy of Scientific Investigation, 1921

ONCE THE NATIONAL INSTITUTES OF HEALTH had declared the existence of a consensus, the controversy over dietary fat appeared to be over. A series of official government reports and guidelines that followed served to confirm it. In 1986, the NIH established the National Cholesterol Education Program (NCEP), which released its first guidelines for cholesterol reduction in October 1987. “The edict has been handed down,” as the Washington Post reported: “total blood cholesterol should be below 200…. If it’s above that threshold physicians must put their patients on cholesterol-lowering diets or use some of the new cholesterol-combating drugs to bring down the levels.” Surgeon General C. Everett Koop’s seven-hundred-page Report on Nutrition and Health, released in July 1988, “exhorts Americans to cut out the fat,” Time reported. The “disproportionate consumption of food high in fats,” according to the Report on Nutrition and Health, could be held responsible for two-thirds of the 2.1 million deaths in the United States in 1988. “The depth of the science base…is even more impressive than that for tobacco and health in 1964,” explained Koop in the introduction, which was certainly not the case. In March 1989, the National Academy of Sciences released its version of the surgeon general’s report, thirteen hundred pages long, entitled Diet and Health: Implications for Reducing Chronic Disease Risk. “Highest priority is given to reducing fat intake,” the NAS report stated, “because the scientific evidence concerning dietary fats and other lipids and human health is strongest and the likely impact on public health the greatest.”